ABSTRACT
Vulval conditions may present to a variety of clinicians, such as dermatologists, gynaecologists and general practitioners. Women with these conditions are best managed by a multidisciplinary approach, which includes clear referral pathways between disciplines or access to a specialist multidisciplinary vulval service. Informed consent is a prerequisite for all examinations, investigations and treatments. Consent is particularly important for intimate examinations of the anogenital area, and a chaperone should be offered in all cases. All efforts should be made to maintain a patient's dignity. Depending on symptoms and risk factors, screening for sexually transmitted infections (STI) should be considered. If the patient presents with vulval itch, particularly if also complaining of increased vaginal discharge, vulvaginal candidiasis should be excluded. Sexual dysfunction should be considered in all patients with vulval complaints, either as the cause of the symptoms or secondary to symptoms, and assessed if appropriate. This guideline covers several aspects, such as diagnosis and treatment, of the more common vulval conditions (relatively) often encountered at vulval clinics, i.e. vulval dermatitis (eczema), psoriasis, lichen simplex chronicus, lichen sclerosus, lichen planus, vulvodynia and vulval intraepithelial neoplasia (VIN).
Subject(s)
Vulvar Diseases/therapy , Europe , Female , Humans , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications/therapy , Vulvar Diseases/complications , Vulvar Diseases/diagnosisABSTRACT
BACKGROUND: Lichen sclerosus (LS) is a chronic inflammatory skin disease. Earlier studies have shown an impaired health-related quality of life (HRQoL), but more extensive research including generic questionnaires has not been reported. OBJECTIVES: To investigate, in a cross-sectional study, the HRQoL of a sample of Dutch women with LS; to compare the resulting HRQoL data with that available from other skin diseases and the general Dutch population; to explore factors that may influence the HRQoL. METHODS: Female members of the Dutch LS Foundation and Support Group filled out three questionnaires electronically: the Skindex-29, the SF-12 and the EQ-5D visual analogue scale (VAS). We distinguished Skindex-29 scores into groups with 'little' (score 0-24), 'mild' (25-31), 'moderate' (32-43) and 'severe' (44-100) impact on HRQoL. We compared differences using the Mann-Whitney U-test and the Kruskal-Wallis test, and correlations using Spearman's rank correlation coefficient. RESULTS: A total of 262 women with LS were included. The average diagnostic delay was 4·9 (SD 7·1) years. Patients had a mean total Skindex-29 score of 38·4 (0-100, SD 17·2). Domain scores for symptoms, emotions and functioning were 46·8 (SD 19·0), 38·2 (SD 20·2) and 33·6 (SD 19·3), respectively. The SF-12 showed average PCS-12 (physical component) and MCS-12 (mental component) scores of 47·7 and 48·5, respectively. For the Dutch population these scores were 49·3 and 52·3. The mean EQ-5D VAS score was 74·1 (SD 15·4). CONCLUSIONS: There is a considerable delay in diagnosis for female Dutch patients with LS. The Skindex-29 domain scores showed a moderately impaired HRQoL. Women with LS reported a lower generic HRQoL than the average female Dutch population.
Subject(s)
Lichen Sclerosus et Atrophicus/psychology , Quality of Life , Adult , Aged , Cross-Sectional Studies , Delayed Diagnosis , Female , Humans , Lichen Sclerosus et Atrophicus/diagnosis , Life Style , Middle Aged , Netherlands , Self Report , Surveys and Questionnaires , Young AdultSubject(s)
Anemia, Hemolytic/etiology , Erythema/etiology , Hypopigmentation/etiology , Leprosy, Multibacillary/complications , Leprosy, Multibacillary/pathology , Mycobacterium leprae , Adult , Drug Therapy, Combination , Erythema/pathology , Humans , Hypopigmentation/pathology , Leprostatic Agents/therapeutic use , Leprosy, Multibacillary/drug therapy , MaleABSTRACT
This guideline aims to provide comprehensive information regarding the management of infections caused by Chlamydia trachomatis in European countries. The recommendations contain important information for physicians and laboratory staff working with sexually transmitted infections (STIs) and/or STI-related issues. Individual European countries may be required to make minor national adjustments to this guideline as some of the tests or specific local data may not be accessible, or because of specific laws.
Subject(s)
Chlamydia Infections , Chlamydia trachomatis , Female Urogenital Diseases/microbiology , Male Urogenital Diseases/microbiology , Sexually Transmitted Diseases, Bacterial/microbiology , Europe , Female , Humans , Male , Practice Guidelines as TopicABSTRACT
A 20-year-old man presented with a five-week history of an eruption of papules and nodules disseminated over his body and face. We propose that this patient has a late form of secondary syphilis with a nodular, granulomatous inflammation in urgent need of treatment. Otherwise late irreversible sequelae could develop and unwanted possible further sexual transmission could take place.
Subject(s)
Syphilis, Cutaneous/diagnosis , Humans , Male , Syphilis, Cutaneous/drug therapy , Syphilis, Cutaneous/pathology , Treatment Outcome , Treponema pallidum/immunology , Treponema pallidum/isolation & purification , Young AdultABSTRACT
In this brief paper, we report persistent high-risk sexual behaviour in a group of men who have sex with men (MSM) after symptomatic lymphogranuloma venereum (LGV) proctitis. Patient records were retrospectively studied and the number of newly acquired sexually transmitted disease (STD) was investigated. It was concluded that a high number of MSM (65%) contracted an STD relatively shortly after the diagnosis of LGV proctitis.
Subject(s)
Lymphogranuloma Venereum/psychology , Proctitis/psychology , Risk-Taking , Sexual Behavior/psychology , Homosexuality , Humans , MaleABSTRACT
We report on a patient who presented with an unusual manifestation of primary herpes simplex virus (HSV) infection. Furthermore, this case again shows that even the correct use of a condom has limited protecting value. We emphasize the usefulness of informing patients carefully about transmission risks of HSV.
Subject(s)
Condoms/virology , Groin/virology , Herpes Genitalis/transmission , Herpesvirus 2, Human/pathogenicity , Skin Ulcer/virology , Adult , Groin/pathology , Humans , Male , Skin Ulcer/pathologySubject(s)
Homosexuality, Male , Syphilis/pathology , Contact Tracing , Exanthema/etiology , Fever of Unknown Origin/etiology , Humans , MaleABSTRACT
OBJECTIVES: Compared to urogenital infections, little is known of serovar distribution in rectal chlamydial infection. The aim of this study was to explore possible relations between demographics, sexual behaviour, clinical manifestations, rectal symptoms, and chlamydial serovars including L2 (lymphogranuloma venereum). METHODS: Genotyping was done prospectively in all rectal chlamydial infections since the outbreak of proctitis caused by lymphogranuloma venereum in February 2003. 33 (15.1%) rectal Chlamydia trachomatis infections from the years 2001 and 2002 were genotyped retrospectively. RESULTS: Of all 219 rectal chlamydial infections, detected in the period July 2001 to August 2005, a total of 149 (68.0%) were successfully genotyped including 21 (14.1%) infections with serovar L2. In univariable and multivariable analyses, L2 serovar positive patients were significantly more often HIV positive (p = 0.002; OR: 6.5; 95% CI: 2.0 to 21.1), and had had sex in the past 6 months with more partners compared to other serovars. Furthermore, patients with L2 proctitis presented far more often with self reported rectal symptoms (p<0.005; OR: 19.4; 95% CI: 4.9 to 77.0) and clinical manifestations (p<0.005; OR: 15.4; 95% CI: 4.5 to 52.5). CONCLUSIONS: Chlamydial infections with serovar L2 show a different clinical and epidemiological pattern compared to serovar D-K. LGV proctitis is significantly associated with HIV positivity and a high number of sexual partners and causes more rectal symptoms and clinical manifestations. Neither young age nor ethnicity were identified as risk factors for any of the serovars investigated in this study.
Subject(s)
Chlamydia Infections/microbiology , Chlamydia trachomatis/genetics , Rectal Diseases/microbiology , Adult , Chlamydia Infections/virology , Condoms/statistics & numerical data , Female , Genotype , Humans , Lymphogranuloma Venereum/microbiology , Lymphogranuloma Venereum/virology , Male , Multivariate Analysis , Netherlands , Proctitis/microbiology , Proctitis/virology , Rectal Diseases/virology , Sexual Behavior , Sexual PartnersABSTRACT
Since the HIV epidemic, the incidence ofanorectal (pre)malignancies in men who have sex with men (MSM) is increasing. The incidence is likely to increase further in the coming years, given that HIV-positive MSM are living longer thanks to powerful antiretroviral treatment. Persistent human papillomavirus (HPV) infection is a major risk factor for the development of anal (pre)malignancies. Less is known about the natural history of anal intraepithelial neoplasia (AIN). Screening in HIV-positive and HIV-negative MSM for anorectal malignancies or dysplasia is cost-effective if the incidence is sufficiently high. Treatment options range from watchful waiting for asymptomatic grade-1 AIN to excision or radio(chemo)therapy for anorectal carcinoma. HPV vaccines are in development. Especially in HIV-positive MSM with anorectal complaints or genital warts in their medical history, one should consider these malignancies.
Subject(s)
Anus Neoplasms/epidemiology , HIV Infections/complications , Homosexuality, Male , Precancerous Conditions/epidemiology , Rectal Neoplasms/epidemiology , Anus Neoplasms/diagnosis , Humans , Incidence , Male , Mass Screening/economics , Papillomaviridae/pathogenicity , Papillomavirus Infections/complications , Precancerous Conditions/diagnosis , Rectal Neoplasms/diagnosisABSTRACT
Clinical recurrences of Herpes simplex virus type 1 (HSV-1)-associated genital herpes are thought to be caused by reactivation of latent endogenous HSV-1. However, the possibility of reinfection with exogenous HSV-1 cannot be excluded. This study aimed to determine the incidence of genital HSV-1 superinfection in patients by investigating the genotype of sequential HSV-1 isolates obtained from the same anatomical site of patients with clinical recurrences of genital HSV-1 recurrent genital herpes. Sequential genital HSV-1 isolates were genotyped by PCR amplification of the hypervariable regions located within the HSV-1 genes US1 and US12. Whereas the sequential HSV-1 isolates in 11 of the 13 patients studied had the same genotypes, the sequential isolates of 2 patients showed a different genotype. The data suggest that HSV-1-induced recurrent genital herpes can be associated with genital reinfection with an exogenous HSV-1 strain.
Subject(s)
Herpes Genitalis/virology , Herpesvirus 1, Human/classification , Herpesvirus 1, Human/genetics , Adult , Female , Genotype , Herpesvirus 1, Human/isolation & purification , Humans , Immediate-Early Proteins/genetics , Male , Polymerase Chain Reaction/methods , Recurrence , Sequence Analysis, DNA , Viral Proteins/geneticsABSTRACT
In mid-December 2003, a cluster of 15 cases of lymphogranuloma venereum (LGV) among male homosexuals was reported to the Municipal Health Service in Rotterdam by the Erasmus Medical Centre's outpatient clinic for sexually transmitted infections (STI). Most patients presented with proctitis and some with constipation. All were Caucasian and between 26 and 48 years of age. Thirteen of them were HIV-positive and eight had a concomitant STI. All men reported having had unprotected insertive and receptive anal sexual contact. Many sexual contacts were anonymous and were reported to have taken place in Germany, Belgium, the United Kingdom and France. This outbreak of LGV may extend through a large part of western Europe. In view of the patients' international contacts, international warnings and alertness are needed. Concerted action of professionals in infectious disease control and curative care is called for.
Subject(s)
Homosexuality, Male , Lymphogranuloma Venereum/epidemiology , Adult , Europe/epidemiology , HIV Infections/epidemiology , Humans , Lymphogranuloma Venereum/transmission , Male , Middle Aged , Netherlands/epidemiology , Sexual Behavior , Sexual PartnersSubject(s)
Choroid Diseases/complications , Hypopigmentation/complications , Vitiligo/complications , Female , Fundus Oculi , Humans , Male , Middle AgedABSTRACT
The incidence of lymphogranuloma venereum (LGV) is low in the western world. Early LGV is characterised by bubonic disease following a painless papule or small ulcer. We report a white bisexual male who presented with a painful perianal ulcer, inguinal lymphadenitis, and concomitant infection with human immunodeficiency virus 1 (HIV-1). Chlamydia trachomatis serovar L2 was identified as the cause after polymerase chain reaction and genotyping the major outer membrane protein by restricted fragment length polymorphism. Treatment with a single dose of 1 g azithromycin was effective. This case illustrates that early LGV may mimic other genital ulcer diseases, such as genital herpes or chancroid, especially in HIV infected patients. In the western world, LGV must still be included in the differential diagnosis of bubonic disease with or without sexually acquired ulcers.
Subject(s)
AIDS-Related Opportunistic Infections/complications , Anti-Bacterial Agents/administration & dosage , Azithromycin/administration & dosage , HIV Infections/complications , HIV-1 , Lymphogranuloma Venereum/complications , Adult , Anus Diseases/drug therapy , Anus Diseases/microbiology , Chlamydia trachomatis/isolation & purification , Groin , Humans , Lymphadenitis/microbiology , Lymphogranuloma Venereum/drug therapy , Male , Ulcer/drug therapy , Ulcer/microbiologyABSTRACT
OBJECTIVE: To describe the results of HIV-surveillance activities in the Netherlands between 1987 and 2001. DESIGN: Descriptive. METHOD: Data were obtained from HIV-surveillance at STI-clinics, laboratory-surveillance in the region Arnhem, surveillance among injecting drug users, the AIDS-notification, STI-registration and the Amsterdam cohort studies on HIV/AIDS. RESULTS: In the Netherlands, the highest HIV-prevalences were found among injecting drug users (1-26%) and homo- and bisexual men (0-17%). In these high-risk populations, an increase in HIV-prevalence and--incidence, respectively, was found among injecting drug users in Heerlen and homosexual men (> 35 years of age) in Amsterdam. The HIV-prevalence was lower among heterosexuals in the Netherlands (0-2%). However, in certain local populations an increase was seen. In both Amsterdam and Rotterdam, the HIV-prevalence was higher in individuals tested anonymously than in those tested by name. CONCLUSION: Local increases in HIV-infections have been observed recently, in both high- and medium-risk populations.
Subject(s)
Acquired Immunodeficiency Syndrome/epidemiology , HIV Infections/epidemiology , Homosexuality, Male , Substance Abuse, Intravenous/complications , Adult , Age Distribution , Cohort Studies , Female , HIV Seroprevalence , Health Surveys , Humans , Incidence , Male , Netherlands/epidemiology , Prevalence , Risk FactorsABSTRACT
The Dutch Institute for Health Care Improvement revised guideline, 'Sexually transmitted diseases and neonatal herpes' summarises the current scientific position on the diagnosis and treatment of a great number of sexually transmitted diseases (STD) and neonatal herpes. Symptomatic treatment of suspected Chlamydia trachomatis infection and gonorrhoea without previous diagnosis is not recommended. Treatment can be started immediately, once samples have been taken. Risk groups eligible for screening or proactive testing on C. trachomatis infection include: partners of C. trachomatis-positive persons, visitors of STD clinics, women who will undergo an abortion, mothers of newborns with conjunctivitis or pneumonitis, young persons of Surinam or Antillean descent, young women with new relationships and individuals whose history indicates risky sexual behaviour. A period of 3 months can be adopted between a risky contact and the HIV test (this used to be 6 months), unless post-exposure prophylaxis was used. For the treatment of early syphilis no distinction is drawn between HIV-infected and non-HIV-infected persons. It is no longer recommended that women in labour with a history of genital herpes are tested for the herpes simplex virus. Virological testing of the neonate is only advised if the mother shows signs of genital herpes during delivery.